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©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
Preemptive endoluminal vacuum therapy after pancreaticoduodenectomy: A case report
Flaubert Sena de Medeiros, Epifanio Silvino do Monte Junior, Romero de Lima França, Heli Clóvis de Medeiros Neto, Juliany Medeiros Santos, Eligio Alves Almeida Júnior, Samuel Oliveira da Silva Júnior, Mario Herman Santos Moura Pedreira Tavares, Eduardo Guimarães Hourneaux de Moura
Flaubert Sena de Medeiros, Heli Clóvis de Medeiros Neto, Mario Herman Santos Moura Pedreira Tavares, Department of Surgery, Federal University of Rio Grande do Norte, Natal 59012-300, Rio Grande do Norte, Brazil
Epifanio Silvino do Monte Junior, Eduardo Guimarães Hourneaux de Moura, Gastrointestinal Endoscopy Unit, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo 05403-000, Brazil
Romero de Lima França, Department of Surgery, Hospital do Coração, Natal 59075-050, Rio Grande do Norte, Brazil
Juliany Medeiros Santos, Gastrointestinal Endoscopy Unit, Faculty of Medicine of ABC, São Paulo 09190-615, Brazil
Eligio Alves Almeida Júnior, Department of Surgery, Instituto Juarez Almeida, Bacabal 65700-000, Maranhão, Brazil
Samuel Oliveira da Silva Júnior, Department of Surgery, Hospital Naval Marcílio Dias, Rio de Janeiro 20725-090, Rio de Janeiro, Brazil
Author contributions: França RL, da Silva Júnior SO, Tavares MHSMP and Almeida Junior EA performed pancreaticoduodenectomy. de Medeiros FS, de Medeiros Neto HC, and de Moura EGH performed the endoscopic procedure. Santos JM and do Monte Junior ES reviewed the case and edited the manuscript; all authors contributed to finalizing the present version of the paper and approved the manuscript for publication.
Informed consent statement: Written informed consent was obtained from the patient.
Conflict-of-interest statement: The authors declare that they have no conflicts of interest.
CARE Checklist (2016) statement: The authors have read the CARE checklist (2016), and the manuscript was prepared and revised according to the Care Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
http://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Epifanio Silvino do Monte Junior, MD, Doctor, Research Fellow, Surgeon, Gastrointestinal Endoscopy Unit, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Av. Dr. Enéas de Carvalho Aguiar, 255, São Paulo 05403-000, Brazil. epifaniosmjr@gmail.com
Received: June 21, 2020
Peer-review started: June 21, 2020
First decision: July 30, 2020
Revised: October 13, 2020
Accepted: October 23, 2020
Article in press: October 23, 2020
Published online: November 16, 2020
BACKGROUND
Pancreaticoduodenectomy is a technically demanding operation, with reported morbidity rates of approximately 40%–50%. A novel idea is to use endoscopic vacuum therapy (EVT) in a preemptive setting to prevent anastomotic leakage and pancreatic fistulas. In a recent case series, EVT was proven to be effective in preventing leaks in patients with anastomotic ischemia. There have been no previous reports on preemptive EVT after pancreaticoduodenectomy.
CASE SUMMARY
We describe the case of a 71-year-old woman with hypertension and diabetes who was admitted to the emergency room with jaundice, choluria, fecal acholia, abdominal pain, and fever. Admission examinations revealed leukocytosis and hyperbilirubinemia (total: 13 mg/dL; conjugated: 12.1 mg/dL). Abdominal ultrasound showed cholelithiasis and dilation of the common bile duct. Magnetic resonance imaging demonstrated a stenotic area, and a biopsy confirmed cholangiocarcinoma. Considering the high risk of leaks after pancreaticoduodenectomy, preemptive endoluminal vacuum therapy was performed. The system comprised a nasogastric tube, gauze, and an antimicrobial incise drape. The negative pressure was 125 mmHg, and no adverse events occurred. The patient was discharged on postoperative day 5 without any symptoms.
CONCLUSION
Preemptive endoluminal vacuum therapy may be a safe and feasible technique to reduce leaks after pancreaticoduodenectomy.
Core Tip: Leaks and fistulas represent a high cost burden to health systems worldwide, with high morbidity and mortality rates in affected patients. Preventing these transmural defects remains challenging. Despite the progress in surgical techniques, pancreaticoduodenectomy still has a high risk of adverse events, including leaks and pancreatic fistulas. Here, we present a feasible technique to reduce these complications of pancreaticoduodenectomy. To the best of our knowledge, this is the first report of preemptive endoluminal vacuum therapy after pancreaticoduodenectomy.
